Basic Information
| Provider Information | |||||||||
| NPI: | 1922411065 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI | ||||||||
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| OtherOrganizationName: | OB/GYN DEPARTMENT OF MOUNT SINAI SLR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 EAST 42ND STREET | ||||||||
| Address2: | 10TH FL. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100175626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466058119 | ||||||||
| FaxNumber: | 6466053029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 10TH AVE | ||||||||
| Address2: | SUITE 10C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100191147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125233452 | ||||||||
| FaxNumber: | 2125238066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2014 | ||||||||
| LastUpdateDate: | 07/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | MACNEILL | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, CBO DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6466058112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.